Mental Health is an uncomfortable subject for many, it calls on us to face our vulnerability, consider our attitudes, and possibly reconsider our bias. Just because we work in healthcare, don’t think we have this covered.
In my years in emergency care, I’ve seen the whole range of emotion, behaviour and deflection play out when it comes to mental health – from denying it’s a ‘thing’ to real love and compassion. I’ve seen lives shattered and beautiful reconnections.
On a more personal note, I know first-hand how devastating, isolating and all-consuming poor mental health can be. On the cusp of adulthood, I suffered a period of extreme anxiety, agoraphobia, panic attacks, the works – it derailed my life completely.
I felt weak, less than my peers, ashamed, inadequate and afraid – for many years after I had recovered from the acute bout. I never talked about it, even within my own family. I went through college, my nursing career, my friendships and early relationships terrified anyone would find out – in doing this I helped maintain the stigma.
In fact, it was one of the most powerful periods of my life, it has totally shaped the human I have become. Yet it has taken me decades to feel able to talk about it – to acknowledge that I, like at least 30% of the population, have suffered poor mental health.
This is why awareness weeks are important. It is not about a hat tip to mental health, it’s about healing – healing the attitudes, the stigma, the judgement even. It’s about making what can sometimes be invisible, visible. It’s about how we stay connected to ourselves and our fellow humans – how we really lean into the discomfort of facing stuff we might not be able to fix.
In healthcare we have two responsibilities here – the way we care for our patients and the attitudes we bring, and perhaps even more critically the way we care for each other and the judgements we make. There is no doubt that this last year made an assault on the mental health of most across the healthcare world at some point or another.
Denying this or pushing it down is not the answer: creating time and space to deal with it is. Some of the principles outlined in Mental Health Awareness week are about connecting with nature – even for a few minutes, they help to ground, connect and energise us for sure. Check out The Mental Health Foundation focus on nature this week, you can check out their aims and evidence here https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week/why-nature
While focussing on what you can do to restore yourself is important, it can be undone in a second by judgement, invalidation and organisational culture.
As well as the practical mental health strategies offered during mental health awareness week, let’s consider the bigger picture here. Let’s start to heal the rift, the othering, the disconnection that our attitudes and beliefs around mental health have created – and by default what people who experience poor mental health endure.
This starts with each of us getting brave enough to look inward at our own views, biases and experiences, then look at what we put out into the world and consider what impact that has. Then the tougher bit, consider whether this is who we want to be or whether we might have some things to reconcile.
Try this short exercise:
- Sit somewhere comfortable where you won’t be disturbed for 5 -10 minutes. You might want a pad & pen to capture your learning, if you journal you may want to allow a little extra time at the end to free write, and you may prefer just to be in the moment, there is no right or wrong here.
- Take a few slow deep breaths to centre yourself
- Now ask yourself what you believe, no judgement – just feel it. Take note of the emotion that comes up, not just the words. How do you feel?
- Then consider where it comes from – is it experience, is it fear, is it inherited, is it true?
- Is this how you want to show up in the world?
- Keep focused on your emotion, what you are feeling, – is there something, someone, or maybe even yourself, you need to forgive, is there anything you need to let go of in order to show up how you want to? Do this now, feel the emotion and let it go.
- What have you learned?
This is the simplest form of healing conversation. Neurologically if we don’t experience our emotions, we can’t fully process what happens to us, our experiences or memories get misfiled or supressed, and our beliefs and attitudes get distorted. Denial, judgement and othering are all examples of this distortion.
Healing conversations enable us to reconnect with what we feel and reprocess and potentially reconcile what we think and how we show up – allowing us to connect more around the things that are important to us.
All healing starts within, hence the conversation with yourself first. As humans we also have a lot of collective healing to do, there are so many global, cultural, national and local issues and none of us can champion everything. I fundamentally believe that connection and contribution are ingredients for good mental wellbeing, so think about what is important to you, what you have control and influence over and start to explore how you can contribute to healing.
For me, one of these things is mental health awareness – rewriting the narrative, reducing fear – and ignorance, acknowledging the progress being made and the journey we still have to go on. In healthcare we need to be mindful of our narrative, our organisational assumptions around resilience and mental toughness and remember that compassion and kindness often have much greater impact.
Poor mental health is debilitating enough, without social stigma, judgement or even well-intentioned avoidance, so this week focus on what you can do. You don’t have to fix stuff, or say the right thing. You just have to show up – this might be a kind word, a connecting smile (masks permitting), or checking in on a friend.
A little thing for you might mean the world to someone else.
Coming back to Mental Health Awareness Week and nature.
All nature, and particularly the sea, is very grounding for me so I’m treating myself to a few days working from the seaside this week, enjoying this force of nature, the picture above doesn’t do it credit! Sea air has evidenced benefit for your neurological wellbeing, it is charged with negative ions, increases oxygen uptake and serotonin production.
Until next time look after yourself and those around you and #ConnectWithNature
The Power of Story – Part 1 – How your brain creates story
Collective story is the basis on which cultures are built – ancient or modern. Your collective stories determine the environment your work in. The way we tell story and consume story has changed throughout history in line with the technology available – the way we process it has not!
Storytelling seems to have been around for as long as we
have. Cavemen used story in the form of drawing and signs on rocks to share
tales and teach about hunting, ancient Egyptians used story to educate,
entertain and communicate – both visually and audibly, antient Greek
philosophers – such as Plato, told stories that still impact the world today.
They understood the power of story, even if they didn’t understand the
neurological workings of why story is important.
“ Those who tell stories rule the world ”.Plato (about 2400 years ago)
Story helps us to make sense of the world around us, it
helps us to connect, to understand and to see perspectives other than our own.
We can dip into a make-believe fantasy world for while, explore other realities
and immerse ourselves in things it may not be practical to experience in ‘real
Coherence is far more important than accuracy when
processing information. Your brain is attempting to sort and react to billions
of pieces of information from internal neuro pathways and external stimuli
every second. It has to prioritise what might create a threat to your safety
and deal with that first.
Think about it like this – if your brain were a rail system
the objective is to get trains from start to destination as quickly and safely
as possible. Information fed to the ‘controller’ forms the basis of decision
making – does the train go straight through, does it need to change line, does
it need to stop completely? The sooner the controller can process that
information the sooner he can move on to the next train. If the controller can
see the whole rail circuit, what else is on the line, what the weather is like
etc, then he can make a rapid decision, if he can only see part of the picture
he cannot. This slows the progress of all trains.
Your brain uses narrative to process information quickly –
that narrative is derived from memories, experiences and neurological conditioning.
There are a number of different parts of the brain involved in memory
formation, the key ones in terms of narrative are:-
which stores linear and autobiographical information, time, space and people.
The amygdala attaches emotional significance to
memory. This emotional significance is critical in how we process information –
strong emotional responses such as shame, guilt, grief, and fear can create a
physiological trigger when faced with similar information in the future.
is also key to forming new memories – particularly those related to fear or
threat to safety. When information is incomplete the brain processes what it
has drawing on narrative from your memory to ‘join the dots’ create the
appropriate physiological response.
The neocortex is
responsible for higher functions and processing in humans – it stores ‘facts’,
language and reasoning, the challenge is that overtime we transfer ‘memories’
from the hippocampus to the neocortex as facts – whether they actually happened
the way we recall them or not.
Why does this matter? From a very early age we tell
ourselves stories about our actions, our experiences and the responses and actions
of others, these stories create a reality within which we exist – this can
either expand our perspectives and horizons or constrain them depending on the
types of story we tell ourselves.
Ultimately, story – whether internally or externally
created, enables us to relate, to connect and to engage emotionally. It drives
our behaviour, our feelings and the action we take. Consciously or not we all
use story to process information and the quality of your stories has a direct
impact on the quality of your life.
Most of this story creation happens at an unconsciously – we
might be aware of the trigger incident, but not the story and neurochemical
reaction attached to it. Until you start to pay attention to your stories they
will be the silent controller of your destiny.
Part two of this storytelling series helps you to unpick
Wilful neglect – is ignoring it collusion?
Pilots who consume alcohol and potentially endanger their passengers, or farmers who deliberately breach food hygiene regulations, like many other professionals face are severe penalties that include loss of license and livelihood, and even potential imprisonment. Should nurses or doctors be any different?
The response to the Government’s plans to criminalise wilful neglect, including in some cases with prison sentences, have been met with predictable outrage by the medical and nursing colleges, who have called it a ‘headline-grabbing exercise’ (BMA). That may have been the press’ agenda, but is it really unreasonable for the Government to hold to account those engaging in wilful neglect?
Making wilful neglect a criminal offence was just one of a number of recommendations made by Don Berwick in his review of the Mid Staffordshire Hospital Inquiry. Berwick’s report also stressed that there are very few examples of wilful neglect in the NHS and (perhaps ironically), called for an end to the ‘blame game’ against NHS staff.
To say nurses and doctors will live in fear of prosecution is scare mongering. Mid staffs happened because of multiple system failures, not because of particular individuals, that was not wilful neglect on the part of clinicians – but individuals allowed disgusting circumstances to prevail. It took relatives and statistics to expose the problem. The fact the staff did not speak out is indicative of a wider cultural issue.
Structural deficits such as staffing levels and quality, budget constraints, poor leadership and work environments collude to leave NHS staff feeling ‘got at’ by health ministers, the press and often by their local organisation leaders too; many of whom appear to criticize the NHS far more frequently than they praise it.
Berwick, in this and many other reports he has authored, is consistently right about culture; and we do need to change the culture in some NHS organisations. We also need to create environments where clinicians to feel safe enough to say ‘No, this is not right’. There also needs to be a route to expose and deal with individuals and systems that wilfully neglect patients – whether clinicians or not!
Critics have expressed concern that it will further reinforce a climate of fear, and unless clarification about what constitutes ‘wilful neglect’ by an individual or group of individuals is made explicit this may be the case. This should not, however be used as an excuse for not taking action. Instead of creating a perceived need to fear accountability for wilful actions, perhaps leaders and influencers should focus on what sits outside of acceptable practice. This will enable the vast majority of clinicians who do a good job, often despite difficult circumstances, to concentrate on patients and care delivery.
There are also places where honesty, transparency and willingness to deal with difficult behaviours and unacceptable practices prevail. They focus on willful improvement to prevent willful neglect ever happening.
Instead of getting caught up in the hype of potential prosecution, perhaps the question we should ask is ‘how do we identify and root out the few in our professions who are prepared to engage in wilful neglect’?